Pneumothorax: What is symptoms, risk?

The term is known but not always understood. What is a pneumothorax? What causes? What symptoms? What risks for the heart?

What is a pneumothorax?

Pneumothorax designates the presence of air between the lung and the chest wall, in the pleural space. This air causes a detachment of the lung, which can then retract. It can occur spontaneously, especially in young man, but also after trauma or be secondary to pulmonary disease. There are different types of pneumothorax:

► Traumatic pneumothorax when the air comes from outside via an external break -in such as a stabb wound or a ball, or an invasive gesture like a puncture (we speak in this case of iatrogenic pneumothorax).

► Spontaneous pneumothorax, it occurs suddenly when the air comes from the lung airways through a breach. Spontaneous pneumothorax is generally benign. It is a pathology of the young subject, more readily affecting the slender, large, thin and smoking subject.

► Cataménial pneumothorax is a recurrent form of pneumothorax, affecting certain women during menstrual cycles. It is generally triggered within 48 hours preceding or depending on the appearance of the rules.

► The compressive suffocating pneumothorax occurs when an abnormal air accumulation of air between the two sheets of the pleura leads to suffocation by pressure on the lungs and on the heart. The pressure exerted is such that other neighboring bodies can be moved, possibly occasioning a stop of the venous circulation and a stop of the cardiac function.

What are the causes of pneumothorax? Stress?

Pneumothorax can occur on a healthy lung without apparent reason. It can if not be secondary to the evolution of a lung disease such as pulmonary fibrosis, emphysema, asthma, cystic fibrosis, pulmonary infectious disease and more rarely cancer … The causes of a compressive suffocating pneumothorax are unknown but it is often due to a serious trauma (e.g. ball injury, road accident). Cataménial pneumothorax is usually the symptom of thoracic endometriosis. The latter corresponds to the abnormal presence of endometrium (the uterus mucosa) inside the chest. Stress cannot cause pneumothorax as well as excessive effort.

What symptoms when you make a pneumothorax?

A pneumothorax leads to compression of the lung which generates pain and difficulty breathing. The chest pain is violent, on the one hand. The inspiration is difficult and at the time of the breath, the patient feels like not to succeed in completely emptying his lungs. A dry cough is possible. Signs of severity can also be present as cyanosis, blue coloring of the skin or mucous membranes, tachycardia and accelerated breathing, a difficulty in speaking. “You must then consult the nearest emergency reception service, or even call 15”recommends Louis Stoffaes, internal in pulmonology.

In case of pneumothorax, the doctor initially performs a physical examination of the patient where he examines the lungs “And can find an auscultatory silence”. A radiography of the lungs will confirm the diagnosis suspected by the clinic by highlighting a line objectifying a detachment of the lung.

Complications: Can we die of a pneumothorax?

Yes but it is very rare, fortunately. “The most serious complication is the death by defusing the heart pump, explains the pulmonologist. Fortunately it is very rare, and concerns traumatic pneumothorax or on a very damaged lung. ” Another complication, benign but very impressive, is the subcutaneous emphysema. “This corresponds to air having infiltrated under the skin, giving a bibendum aspect to the patient.” On the other hand, a pneumothorax cannot cause lung cancer. “But unfortunately, the continuation of smoking can evolve towards lung cancer, pneumothorax can then become a revealing symptom” explains the pulmonologist.

What are the pneumothorax treatments?

There are as many treatments as cases of pneumothorax, but the main goal is to empty the air contained in the pleural cavity.

► When the disease is of low intensity, it is enough for the patient to rest so that the air infiltrated in the pulmonary folds is evacuated. A drug treatment based on analgesics will also be prescribed.

► In the most serious cases, an emergency gesture is practiced: we speak of exsufflation where a needle is introduced into the air cavity. Another technique is pleural drainage using a system sucking gas, which is placed through the ribs using a scalpel. “Among the medical techniques, let us quote the pleural talcing with insertion of talc between the two plevuses, or the mechanical abrasion of the pleura, aiming to make a pleural symphysis -Pleurodèse- to prevent a recurrence”specifies Louis Stoffaes.

“The real problem of pneumothorax is its high recurrence rate” warns Louis Stoffaes. To limit recurrences:

• It is imperative to quit smoking.
• Underwater diving is formally contraindicated after a pneumothorax.
• The plane trip is contraindicated for 3 weeks after a pneumothorax. “If you are a navigating personal, it is best to get closer to an expert center to consider a surgical cry.”
• In pregnant women, recurrences are more frequent, and like catamenial pneumothorax, it requires close gynecological monitoring.

Thanks to Louis Stoffaes, internal in pulmonology and treasurer of the association of young pulmonologists – AJPO2.